Authorized Treatment Letter

nietra

Does anyone have a sample of a letter you send out to employees when you authorize treatment for a work comp. related injury? How about when you deauthorize?

The Work Comp Commissioner for Iowa spoke yesterday at a conference I attended and he said we should be doing this with all of our cases. I have never sent one so I was hoping you could fill me in on what it needed to contain.

Thanks
Nietra

POPEYE

That's what we pay our WC insurance carrier to do. Once we fulfill our obligation of offering a panel of physicians to the EE, the carrier makes all other decision contact.

pork1

NIETRA: We use a multiple copy form on which to fill in the blankets. We made them and have them printed off locally. If you will give me a FAX number, I will zip a copy to you for your use. We use it for both W/C authorizations and authorized drug testing. it works for us!

PORK

System

Our workers comp carrier does the authorization. When a claim is filed, the employee is assigned to an adjuster and a nurse case manager. I'm kept apprised as to the treatment and the return to work status. I don't see how the employer can get involved in authorizing treatment. We may have a good bit of knowledge to the process when an employee is injured, but not the expertise. I say contact your carrier and discuss it with them. You may have been in a meeting with claims adjusters and others who need to know the progress of the employee.

Don D

I agree. The employer is not in the business of tracking improvement of medical condition, case management or approving visits and procedures. That's what the comp carrier is hired to do. I can see providing a piece of paper on the initial visit, but we don't even do that. We do it by phone by calling the clinic when the employee heads in that direction. A third party administrator, by definition, is supposed to administer the program.

In this state, and perhaps yours, the employee has the right to go to a doctor of his choice rather than the one we designate. Don't get hung up in this business of fielding calls from clinics and service providers and trying to play doctor.

nietra

In Iowa the employee can not choose their own provider unless they go thru a legal process with the Work Comp. Commissioner and they deny about 80-90% of requests.

We do have a work comp provider and they do send out letters but I guess I assumed this was something different since this specific training was for those of us that aren't self insured or self administered.

I'll contact our provider today to see if they already meet this requirement for us.

Thanks for your help.

Don D

Even so, don't get roped into the notion that you need to provide written authorizations for treatment. Don't let that become your responsibility. First thing you know, the carrier will be criticizing your decisions on that. Let the carrier work directly with the clinics or either the carrier employs a case manager to coordinate that activity. Typically, you would provide the name, mailing address, fax number and telephone number of your claims rep and let the clinic contact them. They'll be more than anxious to do that since it signals dollar signs for the clinic. Chill Nietra, there are some things you do not have to do, very few, and this is one of them. x:-)

pork1

NIETRA: Now that I have read the other posters, I must disagree with turning the caring eye and attention away form all W/C cases, out right. The owners in my case charge me with the responsibility of understanding what is happening in all W/C cases. There are major points that he makes: 1) get all W/C employees back to work as soon as possible. 2) settlement on any W/C disability claim is a non-starter, if an employee wants to draw disbility on our "nickle" he/she will have to won it in court. I could never be able to turn over the basic case management to our carrier; they are part of the problem (we are on third one in 5 years), they are to quick to listen to the hurt employee and get into settlement discussions without due cause.

This is written to say know what your senior leaders want before you tell them that HRs do not handle this business. That would be wrong! It is I that develops the light duty job descriptions for the physician to approve to make sure the duties are not counter to his limitation orders. It is I that works with the management team to insure we do not have a negative situation developing over light duty or reduced duty. It is I that represents the company in all legal hearings with the W/C cases. It is I that develops the company responses to all legal questions.

I may be one among many that have to be involved for the self-insured companies, but you just might be the additional HR that is also involved like me. More deeply than I would choose, but I do what I am asked to do.

PORK

Don D

Pork: Once again, you are not paying attention. There are many responsibilities an HR professional has involving workers' compensation administration. Claims administration, approving medical appointments, authorizing medical treatment or tests and determining maximum medical improvement are NOT among them. This applies to any business, even yours, assuming you are operating in the 21st century. Getting yourself involved in those areas can land you in the middle of a personal lawsuit quicker than mud dries on the back of a fat, pink sow.

HR has an ongoing responsibility to keep up with WC cases but that does not include case management. I do not frankly think you know what the term means, literally. It does not mean keeping up with the injured employee. Case managers are professionally trained individuals with medical/clinical/claims expertise. You nor I have the training and background to get into medical administration of claims and treatment and release.

Providing light duty is nothing peculiar to the swine industry. It is a worldwide phenomenon. Most of us, I'm sure, do provide what in today's terms is called 'restricted duty', as opposed to the negative connotation of 'light' duty. It is my responsibility as well to provide a job description and work within the limitations set by the physician, not the pig puller, in returning or not returning an employee to work.

It is also our responsibility to monitor the employer's liability by NOT allowing the returned employee to work beyond the restrictions. It is also our responsibility to fire an employee for certain reasons when they might be involved with WC.

If you blindly do nothing more or less than 'what you are told by your senior leaders', you are lucky to still have your shirt.

You have reached the wrong conclusion entirely when you sum up the other posts as recommending she 'turn the caring eye away'. It's just that the rest of us understand our legal limitations, the activities we are allowed to engage in under the state comp rules and regulations and the personal implications of running haywire in every direction in areas that can cost a company last year's profits and land us a personal financial judgement as well.

In this state, which you share, Workers' Compensation is referred to as the 'sole remedy' in cases of industrial injury. That normally means that the employee can only recover money under the limitations and within the rules of the state comp law. HOWEVER, that goes out the window when a company representative knowingly ignores regulations and legal sensabilities. In your case, it could, in fact, transfer complete ownership of your company to the guy you are monitoring and determining medical treatment for. Then you would be fishing full-time, my friend.

pork1

Don: Whoa, what a blast from the past!

Now this post (your post) is more clear and I agree with your specific words and so well laid out for the original poster to get a clearer picture of our HR responsibilities. Your ability to write and get to the "shaft" of an issue is truly outstanding!

Thanks for writing how I am involved. I don't sweat the personal liabilities for my actions because I do understand and do remain intimately involved with the carrier, the physicians, the individual, the case manager, ane the attorneys when they become involved, which is so very seldom because we have learned that the employee who remains in contact with a caring HR or company representive normally gets satisfactory medical attention and back to work. "Back to work" usually keeps the attorneys out of the equation.

I am satisfied that you for one and I for another do represent the employer/employee to the best of our ability and with a caring professional attitude toward the W/C area of responsibilities.

May we all have a Blessed day!

PORK